By Yolanda Mdzeke, Jesse Copelyn
  • South Africa is currently producing more doctors than ever, yet doctor shortages persist in public sector hospitals and clinics, particularly in rural areas.
  • Two things drive this dilemma. The first is that the government often doesn’t have enough money to employ more doctors. The second is that medical graduates don’t want to work in rural areas in the long term, meaning that rural hospitals struggle to attract and retain doctors even when they have the money.
  • One way of fixing shortages in rural areas is to admit more people from rural towns into medical school. This is because people from far-flung areas are more likely to return to practice there than those who come from cities.

The unequal distribution of South Africa’s doctors isn’t limited to the public vs private sector gap. Health workers’ willingness to work in rural areas plays a role too. Most medical school graduates end up settling in urban areas.

South Africa is training more doctors than ever, but state hospitals and clinics are still short-staffed.

In 2021, one in five doctor posts at public clinics went unfilled.

Government hospitals also had staffing gaps. Overall, only 86% of jobs for doctors were filled.

So where do newly trained doctors go?

About half of South Africa’s doctors end up in the private sector. Even though the private sector serves only 27% of the population.

There are over 17 doctors for every 10 000 patients in the private sector.

Government hospitals face a very different reality.

People who use state facilities have almost six times fewer doctors to help. Those who live in rural areas are the hardest hit by this problem.

In parts of Limpopo, there’s not even one doctor for every 10 000 patients.

Why is there a mismatch?

  1. Money

The health department doesn’t have enough money to fill all the posts.

  • Location

Most doctors don’t want to live and work in South Africa’s far-flung areas.

Less than 3% of medical graduates end up working in rural areas 10 to 20 years after finishing their degrees.

Can we fix it?

Medical students who come from rural areas are much more likely to return to far flung places than those who grew up in cities.

One way to get more doctors to rural hospitals would be for medical schools to admit more people from those areas.

That would mean medical schools would have to tweak their admissions processes to favour high achieving students from underserved rural areas.

Some local medical schools already have such policies but there is no national rule about rural students that applies to all universities.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.